NJ hospitals: Obamacare repeal would slam us

New Jersey hospitals would be hit hard by the repeal of Obamacare if Congress doesn't replace it with a law that would include similar levels of insurance coverage, their trade group said Thursday.

Hospitals would lose money from both private insurance and Medicaid reimbursements. They would need to treat more consumers who lose their coverage in emergency departments. And both would put a strain on their bottom line, officials said.

"So many of the strides we've made in expanding access to health care — and in reforming our health care system for the future — are now in danger of being walked back," said Betsy Ryan, president and chief executive officer of the New Jersey Hospital Association.

The hospital group joined what is becoming an increasingly intense fight to keep the Patient Protection and Affordable Care Act, commonly known as Obamacare.

The law, considered former President Barack Obama's signature domestic legislative achievement, is under fire from President Donald Trump and Republican congressional representatives, who have pledged to repeal and possibly replace it — among the issues GOP leaders are discussing in a three-day strategy summit in Philadelphia.

The law requires nearly all Americans to have health insurance or pay a penalty. It provides insurance for nearly 800,000 New Jerseyans. And it set ground rules for the nation's $3 trillion health care system. It has cut the state's uninsured rate in half, but it also has sparked complaints that consumers have to dig deeper into their pockets to pay for care.

New Jersey hospitals have largely come out of the complicated law in decent financial shape. They lost $1.5 billion through lower reimbursements from Medicare and penalties, when they were shown to deliver care that didn't meet quality standards. But they added revenue from consumers who were newly insured.

The result: About 13 percent of the state's hospitals are losing money, compared with one-third of hospitals before the Affordable Care Act went into effect, officials said.

Among the hospital group's concerns:

Nearly 65,000 residents of Monmouth and Ocean counties would lose health insurance they received through the expansion of Medicaid, and 35,000 would lose coverage they bought through the Obamacare marketplace.

New Jersey residents would give up $795 million in federal subsidies that help them pay for health insurance.

The demand for charity care could soar, just as hospitals have seen funding for charity care cut by $350 million in the last two state budgets.

New Jersey's Medicaid program, called NJ FamilyCare, would give up $4.4 billion a year in funding it gets from the federal government.

The GOP has taken steps to repeal parts of the law, but it hasn't yet settled on a replacement.

One idea: Give states a block grant to pay for their Medicaid programs.

"It would likely mean that (New Jersey) would have to reduce the number of people covered under the program, reduce payments to providers, which are already very low, and reduce the scope of services covered," Joel Cantor, director of the Center for State Health Policy at Rutgers University.

Others, however, said block grants would ease the burden on taxpayers and give states a chance to design programs that suited their population.

"Even more important than just block grants, we support fundamental changes to the Medicaid program such as a work requirement that helps people move off of dependency and ensures Medicaid is preserved for the truly indigent/needy," said Erica L. Jedynak, director for Americans for Prosperity-New Jersey, a conservative group. "Work requirements were an unabashed success in the ’96 welfare reform and could be equally effective for Medicaid."

Ryan said additional cuts would hurt hospitals that already agreed to give up revenue through lower Medicare reimbursement and penalties. For example: From 2010 to 2017, Jersey Shore University Medical Center gave up $43.5 million; Monmouth Medical Center in Long Branch gave up $21.4 million; and CentraState Medical Center in Freehold Township gave up $16.5 million, according to the hospital association.

In return, it hoped the law would expand the number of consumers with insurance. The Republican replacement proposals so far don't appear to provide coverage to as many consumers as the Affordable Care Act, Ryan said.

"I think there’s got to be another plan or a supplement to some of the things we’ve seen," she said.